Healthcare Provider Details

I. General information

NPI: 1033031505
Provider Name (Legal Business Name): ARIEL LOPEZ
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9036 ADAMS AVE
HUNTINGTON BEACH CA
92646-3402
US

IV. Provider business mailing address

928 JASMINE CIR
COSTA MESA CA
92626-1722
US

V. Phone/Fax

Practice location:
  • Phone: 714-963-7712
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number53659
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: